老年腰椎间盘突出症患者心理负荷和自我效能对术后康复影响的分析

Analysis of effects of mental load and self-efficacy on postoperative rehabilitation in elderly patients with lumbar disc herniation

中文关键词: 老年  腰间盘突出  遵医行为  心理负荷  自我效能  腰椎功能

英文关键词: elderly  lumbar disc herniation  compliance behavior  mental load  self-efficacy  lumbar vertebral function

中文摘要:

      目的 研究老年腰间盘突出症(LDH)患者心理负荷和自我效能对其术后康复的影响.方法 选取 2022 年 5月—2023 年5 月在淮安市第一人民医院接受经皮内镜下腰椎间盘切除术治疗的108 例老年LDH患者为对象,分别采用腰椎间盘突出患者遵医行为调查问卷、主观负荷评价技术量表(SWAT)、慢性疼痛自我效能感量表(CPSS)和Oswestry功能障碍指数(ODI)评价患者的遵医行为、心理负荷、自我效能和腰椎功能,比较不同遵医行为患者的SWAT评分、CPSS评分和ODI指数;采用二元Logistic回归分析方法,分析SWAT评分、CPSS评分与术后康复遵医行为的关系;采用相关性分析法,分析SWAT评分、CPSS评分与术后腰椎功能改善的关系.结果 本研究问卷回收有效率为 97.22%(105/108),105 例老年LDH患者的遵医行为总评分为(55.04±8.96)分,其中遵医组(遵医行为总评分＞54 分)54 例,非遵医组(遵医行为总评分≤54 分)51 例.遵医组SWAT评分、术后ODI指数均低于非遵医组(t =19.906、4.869,P＜0.05),而CPSS疼痛管理、躯体功能、症状应对及总评分均高于非遵医组(t =5.552、4.650、3.864、6.020,均P＜0.05).2 组患者文化程度、配偶情况比较,差异均有统计学意义(P＜0.05).二元Logistic多因素回归分析结果显示,高SWAT评分(OR =5.140,95%CI 2.082～12.687)是老年LDH患者术后非遵医行为的危险因素(P＜0.05);高CPSS评分(OR = 3.888,95%CI 1.690～8.944)、高文化程度(OR =3.068,95%CI 1.474～6.386)、有配偶(OR =2.257,95%CI 1.037～4.914)均为患者术后非遵医行为的保护因素(P＜0.05).相关性分析结果显示,SWAT评分与术后ODI指数呈正相关(r =0.735,P＜0.05),CPSS评分与术后ODI指数呈负相关(r =-0.681,P＜0.05).结论 老年LDH患者心理负荷越重,可能出现其遵医行为越差,术后腰椎功能改善越差;但自我效能越好、文化程度越高或有配偶的患者遵医行为相对更佳,其中自我效能越好的老年LHD患者术后腰椎功能也更好,值得临床重视.

英文摘要:

      Objective To investigate the effects of mental load and self-efficacy on postoperative rehabilitation in elder-ly patients with lumbar disc herniation(LDH).Methods A total of 108 elderly LDH patients who underwent percutaneous endoscopic lumbar discectomy in First People's Hospital of Huai'an City from May 2022 to May 2023 were selected as the sub-jects.Their compliance behavior,mental load,self-efficacy,and lumbar vertebral function were evaluated with the Compliance Questionnaire,Subjective Workload Assessment Technique(SWAT),Chronic Pain Self-efficacy Scale(CPSS),and Oswe-stry Disability Index(ODI),respectively.The scores of SWAT,CPSS and ODI of patients with different compliance behav-iors were compared.Binary Logistic regression analysis was used to analyze the relationship between SWAT score,CPSS score and compliance with postoperative rehabilitation.The correlation analysis was used to analyze the relationship between SWAT score,CPSS score and postoperative improvement of lumbar vertebral function.Results The effective rate of questionnaire re-covery in this study was 97.22% (105/108).The total score of compliance behavior of 105 elderly LDH patients was(55.04±8.96)points,including 54 cases in the compliance group(total compliance behavior score＞54 points)and51 ones in the non-compliance group(total compliance behavior score≤54 points).SWAT score and postoperative ODI score of the compliance group were lower than those of the non-compliance group(t =19.906,4.869,P＜0.05).The scores of pain man-agement,physical function and response to symptoms,and total score of CPSS of the compliance group were higher than those of the non-compliance group(t =5.552,4.650,3.864,6.020,all P＜0.05).There were statistically significant difference in education level and spouse condition between the two groups(P＜0.05).Binary Logistic regression analysis found that high SWAT score(OR =5.140,95% CI:2.082-12.687)was a risk factor for postoperative non-compliance behavior in elderly LDH patients(P＜0.05).High CPSS score(OR =3.888,95% CI:1.690-8.944),high education level(OR =3.068,95% CI:1.474-6.386)and having spouse(OR =2.257,95% CI:1.037-4.914)were protective factors for postoperative non-com-pliance behavior(P＜0.05).Correlation analysis results showed that SWAT score was positively correlated with postoperative ODI score(r =0.735,P＜0.05),while CPSS score was negatively correlated with postoperative ODI score(r =-0.681,P＜0.05).Conclusion The heavier the mental load of elderly LDH patients,the worse their compliance behavior and the worse the improvement of lumbar function after surgery.Patients with better self-efficacy,higher education level or having spouse have relatively better compliance behavior.Besides,patients with better self-efficacy also have better lumbar vertebral function after surgery,which is worthy of clinical attention.